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Surprise! There is no One-Stop-Shop!

Have you ever been to the Emergency Department where they recommended you see an orthopedic for a broken bone or a Gastroenterologist for chronic abdominal pain, only to be told by the specialists office that you have to have a formal referral from your primary care office?

You may wonder WHY do you have to have a primary care provider and see specialists too? Why can’t one provider do it all?

Have you ever heard the saying “A jack of all trades is a master of none?” Well all physicians and healthcare providers have their basic training. For instance, a pediatrician goes to medical school with a general practitioner as well as a surgeon and cardiologist. They then go on to their residency training where they focus more on their field of choice. Finally, some continue their studies with a fellowship where they further specialize in their field and become experts. These experts often pioneer research in their field and write policies and studies that develop new strategies to heal and cure the body.

Well not all healthcare providers want to specialize, therefore, specialists’ expertise is valuable and their time may be limited and come at a high cost. This is where our primary care providers come in. They are the gatekeepers of healthcare. Primary care providers or PCPs are the “Jack of all trades.” They are the first stop for organizing your healthcare. The PCP knows you the best. They do your annual check-up, order basic maintenance labs and keep you abreast of trends and your personalized healthcare goals. Most ailments can be managed by your PCP and the specialist help is not needed. However, this is not always the case. For instance, if the electricity of your heart started to malfunction, you wouldn’t want your PCP to do a surgical procedure to put in a pacemaker in between their 30-40 patients per day. You wouldn’t want them to figure out what the newest chemotherapy out there for your newly diagnosed tumor is and start it in the office.

This is where the highly trained and MOST knowledgeable specialists come in who are aware and up to speed on the latest and greatest treatments and procedures out there. Heck, they may have even developed them!

Now, back to the original scenario where you were seen in the Emergency department and they recommended you see a specialist. Well can’t they make that assertion? Of course they can! However, your PCP who manages all of your care, needs to be involved. Most of the time, you will have to schedule a visit with the PCP who will review all of the records from the Emergency Dept and then make the referrals as needed. “Why can’t they just review the records and make the referral?” you may ask. Well, you can thank the insurance companies for this.

Over the years, insurance companies have increased standards and requirements on PCPs while either decreasing payments or making it near impossible to manage care on the revenue paid. A PCP could spend several hours of their day reviewing records and updating patients’ charts every day at no financial benefit.

Primary Care Providers have also been tasked with reeling in healthcare costs by decreasing referrals to specialists, eliminating wasteful spending, improving patient health and need for visits and triaging emergency medical needs. All of this with decreased pay or at least no raise from the insurance companies.

So… Think of your primary care provider a your First Stop! Most PCP copays are cheaper than specialists! They can manage most of your ailments or at least get you to the right person if they can’t. Think of your PCP as the Manager of Your Health. They keep you moving in the right direction!

Keep in mind that this is the process in North Carolina where I practice but all states are different. Please comment and let me know your experiences in your state.